Healthcare Provider Details

I. General information

NPI: 1114556040
Provider Name (Legal Business Name): IRISHA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 10/27/2023
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10462 HIGHDALE ST
BELLFLOWER CA
90706-4123
US

IV. Provider business mailing address

10462 HIGHDALE ST
BELLFLOWER CA
90706-4123
US

V. Phone/Fax

Practice location:
  • Phone: 562-316-6629
  • Fax:
Mailing address:
  • Phone: 562-316-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95013590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: